Contract Cheating in Health Courses (Unpublished Paper)

Here is an unpublished full paper that was otherwise gathering virtual dust on my hard drive.

Examining Contract Cheating, Essay Mill Use and Academic Misconduct by Students on Health Courses – from 2015 – Thomas Lancaster and Robert Clarke
(Full Text including PDF Download on ResearchGate)

I originally wrote this in 2015 based on a talk that Robert Clarke and I delivered. The problem of contract cheating in health and nursing education was prominent then and I have addressed this in subsequent talks and on this blog.

The paper was never submitted for publication, as the conference I was originally aiming this at didn’t run and I haven’t subsequently seen the right outlet. Looking back at the paper with 2018 eyes, it would need a substantial rewrite to fit suitably into the current academic integrity climate. This would include updating the sources and examples, so that it was substantially a new paper.

Due to this, I am providing the original unpublished paper here as drafted in the hope that it may be useful to researchers instead.


When students obtain academic awards in the health industry that they do not deserve, they may emerge unfit for professional practice. This paper explores the challenges posed by academic misconduct in public-facing health fields, such as nursing and medicine. Specifically, the paper explores contract cheating, where students employ a third party or ghostwriter to complete assessed work. The problem appears more crucial in health than some other academic disciplines, since here fitness for practice is important and human lives may be at stake.

The paper argues about the importance of academic integrity in health through multiple examples. This includes showcasing media cases where medical professionals have been put in positions which their skills did not warrant and giving three specific examples of attempts by students to cheat that have been detected online. The examples demonstrate that such contract cheating starts before students arrive at university. This misconduct continues throughout their academic career up to postgraduate level. The overall findings in this field support the view that contract cheating is habitual and repeated regularly by some students.

Several sources are used to show that contract cheating in health is amongst the most popular subjects that students cheat on. Other examples show that original essays and assessments can be purchased by students for affordable prices. These essays will not be detected as unoriginal by Turnitin. The paper concludes by arguing that increased academic pressure is needed to change the wider health culture that is affording contract cheating.

There is still a need for research in this field. In particular, this includes gathering more data and implementing subject specific solutions. I would like to look back at this area again as time and opportunities permit.

I’m always open to speak on contract cheating and essay mill use in health education (you can contact me here).




Beyond Contract Cheating – Towards Academic Integrity

I explored the issue of contract cheating and the growing movement towards academic integrity as part of a teaching and research seminar at the University of St. Andrews.

You can see the slides used in the presentation on my SlideShare account. They are also embedded below.

This was one of the most respectful audiences that I’ve ever presented for, with an extended period of questions and answers afterwards. I was also pleased to see students in the audience.

From the discussion, it was clear that many in the audience hadn’t really considered that contract cheating happened. I hope the discussion we had about assessment design techniques was useful. I don’t think that it’s ever possible to completely design out cheating from assessments, but it is possible to make this a strategy that students wouldn’t consider effective to use.

Contract Cheating – The Threat To Academic Integrity And Recommendations To Address Essay Mill Use – Video

Here is a short video introduction to why contract cheating is a problem (it only last 1 minute and 39 seconds).

The video uses some of the recommendations from the Quality Assurance Agency (QAA) report on contract cheating, released in October 2017. I was part of the team steering the report and have been speaking about it in media interviews. It’s great to see the national push asking universities to address this form of academic misconduct.

If you find the video useful, feel free to go ahead and share it. The direct link to the YouTube page is here.

What I don’t do in the video is define contract cheating or go into a lot of detail about it. I deliberately wanted to keep this one short and shareable.

The video looks at why contract cheating is an issue, some recent numbers about the extent of contract cheating (the source in the video says that 7% of students have contract cheated at least once) and to look at solutions, particularly regarding the movement to work with students and promote academic integrity.

If you prefer to read, or want more information, a longer version of the same contract cheating story is on my Linked blog.

Contract Cheating and Essay Mills 2017 Findings Part 7 – Understanding Contract Cheating From The Student Viewpoint

This is Part 7 (the final part) of the 7 part series examining Findings From Plagiarism Across Europe and Beyond 2017

It was really positive to see the views of students strongly represented at Plagiarism Across Europe and Beyond 2017. There were some student participants (I’d like to see support for more students to attend), as well as presentations where the views of students were directly reported.

Why Do Students Resort To Contract Cheating?

The question about why students cheat, plagiarise and fail to demonstrate academic integrity is a long-standing one. The specific analysis of the motives behind students resorting to contract cheating is less developed, but many wider principles still seem to hold.

The issue of the marketisation of higher education was discussed at several points during the conference. Wendy Sutherland-Smith said how students perceived buying an essay as just a business deal, citing some of my work with Robert Clarke where we’ve observed similar behaviours. Other people said that the high cost of fees was a main cause of contract cheating.

Although I’m sure that there are elements of truth here, and I’ve referred many times to the cost of failure, where the prospect of having to repeat a year and pay high fees makes contract cheating into a risk that some will feel is worth taking, marketisation itself does not tell the whole story. I think this is a reason that some students are using to justify cheating, rather than the cause of it.

To back this idea up, I’d also refer to the SEEPPAI work I’ve been involved with in Europe, as well as developments I’m aware of in the wider world. Contract cheating still seems common in countries with no fees and even in places where students are awarded a grant. This means that discussions about the reasons why contract cheating takes place can’t be boiled down into a simple soundbite.

What Factors Contribute To Contract Cheating?

Several presentations considered why contract cheating takes place. Students in the Czech Republic, as surveyed by Veronika Kralikova, gave a single main reason which must also sum up a lot of quick turnaround advertisements made by the essay industry. Their reason for contract cheating was a lack of time.

Student advocates form Australia who worked alongside Wendy Sutherland-Smith identified multiple reasons why contract cheating took place. A main reason for contract cheating was fear of failure, an area that could be considered a possible consequence of a lack of time. Two more views from this work are also worth considering. The first was where students were said to have a goal of passing a subject, not learning about it, perhaps particularly relevant where they did not feel they would use the subject in the future. The second was where students were said to be not understand the seriousness of contract cheating. Those latter two views do not closely overlap, so it may be that there are several conceptions about contract cheating that need to be considered when working with students.

One of the main recommendations to come back from the work with student advocates in Australia is that students need specific modules on academic integrity. These modules need to be mandatory and a step change from the single lecture telling students not to plagiarise that is all that many students seem to get now.

Further, the teaching of academic integrity needs to be addressed on a global level. During our SE Europe research for SEEPPAI, we identified that many students are not even taught the basics about plagiarism, referencing or academic writing. These are core ideas that need to be taught as the basis for a strong commitment to academic integrity and reinforced for both staff and students continually throughout an academic career.

Working In Partnership With Students

I was very pleased to see the presentations and contributions about working in partnership with students to reduce contract cheating. Having a senior member of the National Union of Studies (NUS) in the UK attend the conference also showed how the issue is being considered as vital for discussion on a national level.

As well as providing something of a general theme, work with student advocates also provided the focus for Wendy Sutherland-Smith’s presentation.

Wendy also mentioned the fantastic work going on at Deakin University looking at contract cheating awareness, which has really led the way for activities going on in other countries. Deakin ran a contract cheating awareness week last year and plans to repeat it this year.

More widely, the first International Day of Action on Contract Cheating took place in 2016, with universities around the world participating to use local activities and social media to have a positive influence on academic integrity. I’m delighted to say that this activity is happening again in 2017.

The second International Day of Action on Contract Cheating will take place on 18 October 2017. I hope that many more universities can take part.

Contract Cheating and Essay Mills 2017 Findings Part 6 – Which Students Are Contract Cheating And What Does This Mean For Assessment?

This is Part 6 of the 7 part series examining Findings From Plagiarism Across Europe and Beyond 2017

As Tracey Bretag said at the opening conference keynote, it is just not possible to set an assessment for which cheating is impossible. Despite that, there is still much good practice to be considered when setting assessments to benefit the students who engage with it.

Highly unusually, I think that this is the first conference I’ve been to in a while where I didn’t once hear the term “authentic assessment”. With that said, several of the recommendations from conference speakers support the ideals of authentic assessment in all but name.

Which Students Are Contract Cheating?

Several studies presented at the conference showed progress towards answering the difficult question regarding how many students are contract cheating, or if certain groups of students engaging in the practice can be identified.

In her opening keynote, Tracey Bretag settled on the figure of between 6% and 10% of students having contract cheated at least once. That figure remained mainly consistent across the conference. Tracey did note that there was no significant difference in the cheating figures between the universities that Australia defines as elite and non-elite. I suspect that the same would be true in the UK, even though the figures that UK universities choose to report to the media can differ substantially.

Veronika Kralikova surveyed over 1000 students in the Czech Republic and found that over 8% of them had contract cheated. Veronika also observed a gender difference, with 5% of female students saying that they had contract cheated, but 15% of male students stating this. She also found that 34% of the students said that they knew someone else who had contract cheated, suggesting that this isn’t an activity that students keep quiet about.

Several other groups of students likely to be susceptible to the temptation of contract cheating were also identified in Tracey Bretag’s presentation, with numbers based on a survey of 14,086 students on courses at universities in Australia. 814 of these students said that they had carried out one or more behaviours classified as cheating on a wider scale.

15.8% of the overall survey responders were international students, but 33.0% of the cheating group were international students.

13.1% of the overall group were engineering students, but when looking at just the cheating group, this figure rose to 24.6%.
It does need to be stressed that the cheating behaviours do not just cover contract cheating and also include areas like hiring an exam impersonator or cheating in an examination, but the overall figures do suggest that there could be issues to overcome regarding contract cheating that are specific to the engineering discipline.

The identification of engineering is interesting, as many of the listings of the subjects where most contract cheating is found, including some of my own studies, identify the areas taught in a Business School as most at risk. Business was not singled out in Tracey’s presentation. However, there is still analysis to be done. It may be that Business has been a red herring, with the contract cheating numbers appearing high simply because there are a lot of students taking the subject. It may also be that engineering numbers are bolstered in this study due to examination cheating. The full analysis will be interesting.

There may also be an overlap between the international student group and the engineering student group.

Tracey also verbally noted that the highest cheating levels seemed to be related to groupwork, with a possible overlap to engineering. Contract cheating and groupwork is an important area to consider regarding assessment design. I’ve previously suggested that well-designed groupwork can make contract cheating difficult, since this can be structured to require group complacency with contract cheating. However, I’ve also observed outsourcing requests on agency websites where students are just sending their section of a piece of groupwork to a third party. To me, that isn’t groupwork at all, it’s just standard assignments which can be completed individually.

Further, I recall a presentation at the Western Australia Forum for Contract Cheating where the presenter talked about whole groups of students agreeing to outsource their tasks as a collective. And, in that case, groups largely consisted of international students. This means that just assigning groupwork, on its own, is not a solution for contract cheating. More research into how to develop successful and authentic groupwork assignments in the age of contract cheating is needed.

What Assessments Are Susceptible To Contract Cheating?

Why students cheat and plagiarise is a long-standing question, but the answers do support types of assessment that may work better than others.

Tracey Bretag presented the results of a survey of more than 14,000 students in Australia that was used to identify which types of assessments they were most likely to outsource. The top three were: (1) assignments with a short turnaround, (2) weighted assignments and (3) continuous assessment. Hannah Sketchley, representing the National Union of Students in the UK, gave supporting results from her investigations, where “high stakes assessment” was of concern. From a practical viewpoint, I can see that, but from a pragmatic viewpoint, I also know of students who complain about overassessment when there are too many assessment points in a module. That may also support the high ranking given for the likely outsourcing of continuous assessment.

Indeed, in my presentation I discussed the growth of sites designed to complete every assignment on a course or module for a student and such sites appear highly targeted at students with lots of small assessments. It will be interesting to see what the recommendations are that will rationalise two concerns that seem to be polar opposites.

The issue of assignments with a short turnaround continues to be of concern as there is no evidence suggesting any benefits to students here. I’ve shared many examples I’ve shown of student assignments being completed by third parties in a matter of hours and Phil Newton has analysed turnaround times by individual writers to show that they can deliver work quickly (and may even like the faster turnaround times as they can charge a premium price). Phil shared an interesting observation from an essay mill that now defaults to a three-day turnaround on the site. This suggests that essay mills have decided that fast turnaround this is the best way to market their offer.

The results from Tracey’s survey were not all doom and gloom. She also identified the three factors that students said would make them least likely to outsource an assignment. These were: (1) reflections of practice, (2) viva and (3) personalised and unique. I’ve long since advocated on the increased use of vivas within higher education assessment. They are not perfect, but can work well if used in a controlled manner. The other ideas are worth considering. Many essay mills offer reflective writing, although it may be that students choose not to order this.

Personalised assignments are another good way to increase student engagement, but like the other assignment types, they are not foolproof. I’ve observed many examples of students outsourcing project reports and dissertations, getting this back a chapter at a time and returning the comments of their supervisor to their hired writer. There are whole sites that market themselves solely as dissertation and capstone project suppliers. I’ve seen lots of examples of dissertation outsourcing at MBA level and have also observed requests at PhD level. Other safeguards still need to be in place here.

Teddi Fishman suggested a possible variant on the viva which may be worth trying. In this assessment, students give a presentation based on the topics they’ve learned about in the module. The twist is that they don’t know what will be on the presentation slides until they arrive in the assessment room. If anyone does test that one out, please let me know how well it goes.

Contract Cheating and Examinations

One suggestion that is often made when contract cheating is discussed is to simply use examinations again. That may be a partial solution in some cases, but it’s not a complete solution. I was pleased to see that I was not the only person presenting on the challenges posed by examinations. This topic found its way into several other presentations.

In the survey of over 14,000 Australian students reported by Tracey Bretag, she found that 0.2% of students had got someone else take an exam for them. Of the students getting someone else to take an exam for them, only 10% has paid money. By contrast, 0.5% of students said that they had taken an exam for someone else, of which 16.7% received money. I do think that some caution needs to be applied to those figures, as many seem to use exam as an interchangeable term for assessment. If correct, the difference between these figures has to be of interest.

Tracey’s team also surveyed over 1000 academics working at Australian university. They found that 5% of staff had observed impersonation in examination, a number that is much higher than I would have anticipated and has to be of alarm.

Bob Ives presented his work in progress regarding cheating in Moldova and Romania. Both countries were said to have substantial problems with examination cheating, including through impersonation and through the use of unauthorised materials in the exam.

I was also introduced to a site I haven’t seen before,, where individuals in India post about bribes they’ve (had to) make. India has often been in the news regarding exam cheating and unsurprisingly the site contains several hundred examples of bribery relating to exams, including examples of bribe payments being required to pass driving tests, engineering certifications and even to qualify as a medical doctor. It’s a site I need to explore further.

My own presentation showed several examples where people attempted to outsource their examinations, including university students and people taking professional exams. Tests taken on a computer looked to be particularly susceptible here. Students were seen using several novel ways to communicate with people outside an examination hall, including instant messenger services like WhatsApp. If communication like this is successfully happening, some changes regarding examination security are necessary.

I also discussed the availability of other technology, particularly the hidden earpieces that were found to be prominent during our SEEPPAI research and allow someone outside an examination hall to whisper answers to a student inside it. A question was raised regarding how such exam cheating technology works, so cheating devices is also an area that I feel needs to receive more widespread communication with the academic audience.

Assessment Recommendations

The same principles regarding good assessments repeated themselves in several different ways during the conference. One of the main ones has to be to stop essay writing being a main part of the requirements for an academic qualification. These are assessments that are susceptible to contract cheating and are “bread and butter” to writers for contract cheating services. As several presenters expressed in different ways, if a writer can turn out multiple essays on multiple subjects a day, then these can’t be essays that are worth writing or reading. But yet, such essays still seem to be being purchased and they still seem to pass.

Hannah Sketchley said that there was a need to co-design assessments with students. It’s not the easiest thing to get right, particularly to also comply with quality processes, external expectations and professional body requirements, but this is certainly a direction to strive towards. A similar recommendation to redesign assessment to remove high stakes components also came from Wendy Sutherland-Smith. Wendy has been attempting this but she also noted that this approach had heavy resource implications which may not prove sustainable in the long term.

Teddi Fishman summed up the challenges posed by contract cheating and assessment well at the keynote that closed the conference. Teddi advocated that “we must require our students to be active participants in their own learning”.

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